Annals of clinical and translational neurology · 2026
A Two-Stage Questionnaire and Actigraphy Screening for iRBD in a Multicenter Retrospective Cohort.
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Massimi Caleb A, Mejia Giorgio Ricciardiello, Metzger Andre, Ryu Kang Hyun, Marwaha Salonee, Grzegorczyk Eva, Zhou Li, Jacobs Eliana, Gilyadov Boris, Kunney Claudia, Ncube Liqhwa, Parekh Ankit, Mignot Emmanuel, Elahi Fanny M, Winer Joseph, Poston Kathleen, Brink-Kjaer Andreas, During Emmanuel H
Аннотация
OBJECTIVE: Isolated rapid-eye-movement sleep behavior disorder is a prodromal marker of synucleinopathies. However, most cases remain undiagnosed due to the insufficient predictive value of questionnaires and limited access to confirmatory video-polysomnography. We assessed a two-stage screening strategy combining a brief questionnaire on rapid-eye-movement sleep behavior disorder symptoms and other prodromes with wrist actigraphy across multiple case-control cohorts.
METHODS: Participants aged 40-80 without neurodegenerative disease were recruited from five cohorts; all cases were confirmed by video-polysomnography. The questionnaire was administered to 289 participants, and 236 underwent ≥ 14 nights of home wrist actigraphy. The wearable-based algorithm was built on four movement features (mean motor activity, activity index, short or long immobile bouts, twitch activity). Models were trained with nested cross-validation using XGBoost.
RESULTS: The full retrospective cohort included 396 participants (99 cases, 297 controls; mean age 64 ± 11; 55% male). The dream enactment question alone achieved an area under the curve of 0.85, which improved to 0.86 using the four-item questionnaire. Actigraphy alone achieved 82% sensitivity and 84% specificity. In the subgroup completing both assessments (75 cases, 54 controls), the two-stage protocol-questionnaire followed by actigraphy-yielded 68% sensitivity and 100% specificity using the dream enactment question alone, and 73% sensitivity and 100% specificity using the four-item questionnaire.
INTERPRETATION: A two-stage protocol combining questionnaire and actigraphy demonstrated high specificity and good sensitivity for detecting isolated rapid-eye-movement sleep behavior disorder in this multicenter cohort. This low-cost, scalable strategy is compatible with widely used wearable devices and warrants validation in community-based populations.
METHODS: Participants aged 40-80 without neurodegenerative disease were recruited from five cohorts; all cases were confirmed by video-polysomnography. The questionnaire was administered to 289 participants, and 236 underwent ≥ 14 nights of home wrist actigraphy. The wearable-based algorithm was built on four movement features (mean motor activity, activity index, short or long immobile bouts, twitch activity). Models were trained with nested cross-validation using XGBoost.
RESULTS: The full retrospective cohort included 396 participants (99 cases, 297 controls; mean age 64 ± 11; 55% male). The dream enactment question alone achieved an area under the curve of 0.85, which improved to 0.86 using the four-item questionnaire. Actigraphy alone achieved 82% sensitivity and 84% specificity. In the subgroup completing both assessments (75 cases, 54 controls), the two-stage protocol-questionnaire followed by actigraphy-yielded 68% sensitivity and 100% specificity using the dream enactment question alone, and 73% sensitivity and 100% specificity using the four-item questionnaire.
INTERPRETATION: A two-stage protocol combining questionnaire and actigraphy demonstrated high specificity and good sensitivity for detecting isolated rapid-eye-movement sleep behavior disorder in this multicenter cohort. This low-cost, scalable strategy is compatible with widely used wearable devices and warrants validation in community-based populations.